Provider Demographics
NPI:1336128545
Name:WIGGINS, RONNIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:D
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934399
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-4399
Mailing Address - Country:US
Mailing Address - Phone:770-232-8611
Mailing Address - Fax:
Practice Address - Street 1:4370 W MAIN ST
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1056
Practice Address - Country:US
Practice Address - Phone:334-793-5000
Practice Address - Fax:334-615-7281
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19429207L00000X
ALMD 19429207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100679Medicaid
AL051548708OtherBCBS
GA605331107AMedicaid
FLPENDINGMedicaid
AL100679Medicaid
G18722Medicare UPIN